[LeviProcter]

quote ajm222:

Have you ever seen someone diagnosed with a hernia only to go under for surgery and find a lipoma instead? Wondering if that’s unusual after a physical exam.

Yes, it’s not uncommon. The fat is plugging the hernia. So,even though a “hole” is not initially observed, once the flap is taken down and fat removed you have a hernia.

[LeviProcter]

Great news. Happy to answer any questions here or by email. Good luck!

[LeviProcter]

Agree with Dr. Towfigh. It’s highly probable it’s a trocar site incisional hernia.

[LeviProcter]

Ultrasound will miss these. CT can also. If you do get a CT then make sure you “bear down” (like having a bowel movement) during the scan itself to increase gut pressure to stretch out increase ability to see the defect.

[LeviProcter]

You have hernias.
I agree with Dr. Twofigh about considering surgical repair.

[LeviProcter]

Recurrence repair should be done by a hernia specialist.

Typically repeat repair is not done through same approach (typically). If an open repair is done and recurs then you approach via a posterior (MIS aka lap or robotic approach) and vice versa. That’s a basic tenet but not always applicable. It requires a lot of thought and risk assessment by the surgeon.

[LeviProcter]

Core exercises (planks, etc) can strengthen core.
None of these will fix a hernia. Goal is to prevent them from coming out less often by strengthening the abdominal wall therefore making the hernia defect have less laxity and change the contour of the defect to be less accommodating
.
Also, avoiding smoking and strive for weight loss to decrease fat on intestines to lower intra-abdominal pressure to prevent abdominal contents from pushing into them. High fiber diet and lots of water to making defecation less stressful and require less abdominal pressure.

[LeviProcter]

All sounds expected.
I don’t perceive any real issues.
Be active as pain allows.

[LeviProcter]

I would get CT with valsalva during scan.
Pauli and Zuckerbraun all capable.
Seeing an orthopedist is fine but they don’t fix sports hernias.
I’m happy to look at your scan if you need.

[LeviProcter]

quote Good intentions:

You seem to be overlooking completely the views of us that weren’t fine. I had my surgery in 2013 from a skilled well-known surgeon, using state of the art materials and methods. Nobody can guarantee that somebody getting hernia repair will be fine. There is still much luck involved, and many surgeons can’t really say if their past patients are fine or not. Nobody is keeping track. I wish it wasn’t true, but I’m a pretty smart guy, and I still got caught. Still figuring out how it happened.

Good luck kevin-pa. Do the ground work, and don’t let your guard down at the comforting words.

I appreciate your thoughts and position. I’m sorry you did not have an optimal outcome. Thankfully, many in your situation, can achieve a cure.

Recognize that there are also serious complications (can supercede chronic groin pain, such as bowel perforation, bowel resection, etc) that can occur with a symptomatic hernia that isntrepaired.

Everything has risk.

Albeit this type of data on chronic pain, poor outcomes, is not recorded the overall outcomes in the literature support benefit at greater than risk.

Even in the most expert hands these issues can happen. We don’t fully understand chronic groin pain etc to be able to prevent in all patients.

Nothing can be guaranteed. You are correct.

One has to know risks on both sides of this equation and make a judgement that they can live with.

My comment above is a generalization, I recognize that, but the large majority do well.

[LeviProcter]

Agree with surgical weight loss first.

This repair should be done by someone with lots of experience.

These large mesh based repairs are successful but can have very serious complications.

[LeviProcter]

MRI can miss occult (hidden) hernias. If all other workups have been exhausted sometimes a diagnostic laparoscopy is warranted to look at the abdominal wall/groin from the inside and/or dissecting in the area of concern. I have operated on plenty of patients with a negative MRI, US, CT that have groin hernias found at laparoscopy.

[LeviProcter]

Probably a cord lipoma in your inguinal canal.

I can review your CT imaging if you wanted to send it to me. Many surgeons and radiologists don’t appreciate true cord lipomas as being akin to a hernia on CT.

[LeviProcter]

I’m new to Richmond, VA.

I haven’t heard anything negative.

[LeviProcter]

It’s likely a trocar site hernia. This is the same as an incisional hernia.

I would put money on it.

[LeviProcter]

Pain that is gone after surgery but comes back that is similar as before makes me concerned about hernia recurrence (can happen even with no bulge, etc).

You need an evaluation by a surgeon that deals with recurrent hernias.
They will need your op notes, any imaging you have on CD w/reports.
They will get a history, physical and do an exam.
If they feel it’s nerve related they can do dermatome map testing in the office in a few minutes.

[LeviProcter]

What type of hernia(s)?
How was it repaired? Lap, open, robotic?
Was mesh used?

3 months with these symptoms is not typical.
You need evaluation by a surgeon that does hernia repairs.
Does the surgeon that did you operation have any partners that could evaluate you?

[LeviProcter]

Before getting imaging, sometimes a referral to a general surgeon can diagnose a hernia related issue without imaging.

Ultrasounds are user dependent and can miss hernias.

CTs can miss hernias, you can increase hernia identification by doing a valsalva (bearing down like you were trying to force out a bowel movement to increase intra-abdominal pressure) during the CT scan.

[LeviProcter]

Pass gas.

Holding will just increase abdominal pressure and make your hernia symptoms worse.

[LeviProcter]

quote kevin-pa:

Thank you again everyone. I really appreciate all of the responses. What is strange is in the last few weeks the hernia has begun to bother me. Originally it was only after long days. Now I have a heaviness/pressure sensation depending on the way I stand or sit. I have a window of time from Jan-April where I am not working much as my current job is largely seasonal. It would be a good time to get the repair done.

Now comes decision time. Choosing a doctor, mesh or no mesh, lap or open, having it now vs. waiting, measuring current pain level vs. potential life changing forever chronic pain that could be much worse. I wish it was easier to decide.

It’s great that the internet has allowed us to communicate quickly, research info, and have forums like this. But it also opens up the flood gates of “what-if’s” and overwhelms your mind in terms of the amount of information. I would bet the internet has drastically increased the number of hypochondriacs on this planet.

We can recommend expert, competent surgeons that can offer you the best outcome irrespective of the operation chosen.

You will be fine.

I would get it fixed.

I would consider traveling to a surgeon that is recommended if there isn’t one in your area.